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They’d worked together for over a year but almost all their conversation had been about the present. The ER was like that. You lived in the moment in every sense.
“Three generations. My father and grandfather both worked in primary care. They had a practice in upstate New York.” He’d sat, five years old, in the waiting room watching as a steady stream of people trooped through the door to speak to his dad. There had been times when he’d wondered if the only way to see his father was to get sick.
“And your mother?”
“She’s a pediatrician.”
“Jeez, Black, I had no idea. So it’s in the DNA.” Susan yanked a paper towel from the dispenser so vigorously she almost removed it from the wall. “Well, that explains it.”
“That explains what?”
“Why you always act like you have something to prove.”
Ethan frowned. Was that true? No. It certainly wasn’t true. “I don’t have anything to prove.”
“You’ve got a lot to live up to.” She gave him a sympathetic look. “Why didn’t you join them? Doctors Black, Black and Black. That’s one hell of a lot of Black right there. Don’t tell me, you just love the warm fuzzy feelings that come from working in the emergency room.” Through the door they heard the woman yell fuck you and exchanged a wry smile. “All those cute patients enveloping you with endless love and gratitude—”
“Gratitude? Wait—I think that did happen to me once, a couple of years ago. Give me a moment while I cast my mind back.”
He didn’t feel as if he had to live up to anything.
Susan was wrong about that. He walked his own path, for his own reasons.
“You must have been hallucinating. Lack of sleep does that for you. So if the rare dose of gratitude isn’t what does it, it must be the patients who curse you, throw up on your boots and tell you you’re the worst doctor that ever graced god’s earth and that they’re going to sue the hell out of you. That works for you?”
The humor got them through days that were fraught with tension.
It sustained them through the darker shifts, through witnessing trauma that would leave the average man on the street in need of therapy.
Everyone in the trauma team found their own way of dealing with it.
They knew, as most people didn’t, that a life could change in an instant. That there was no such thing as a secure future.
“I love that side of it. And then there’s the constant buzz of working with adoring, respectful colleagues like you.”
“You want adoring? Pick a different woman.”
“I wish I could.”
Susan patted his arm. “In fact I do adore you. Not because you’re cute and built, although you are, but because you know what you’re doing and around here competence is as close as it gets to an aphrodisiac. And maybe that’s driven by a desire to be better than your daddy or your granddaddy, but I love it all the same.”
He shot her an incredulous look. “Are you hitting on me?”
“Hey, I want to be with a man who is good with his hands and who knows what he’s doing. What’s wrong with that?” Her eyes twinkled and he knew she was winding him up.
“We are still talking about work?”
“Sure. What else? I’m married to my job, same as you. I promised myself to the ER in sickness and in health, for richer and for poorer and I can tell you that living in New York City the emphasis is definitely on poorer. But don’t worry—I wouldn’t be able to stay awake long enough to have sex with you. When I leave this place I fall unconscious the moment I arrive home and I’m not waking up for anyone. Not even you, blue eyes. So if you’re not here for the love and positive feedback, it has to be because you’re an adrenaline junkie.”
“Maybe I am.” It was true that he enjoyed the fast pace, the unpredictability, the adrenaline rush that came with not knowing what would come through the doors next. Emergency medicine was often like a puzzle and he enjoyed the intellectual stimulation of figuring out where the pieces fit and what the picture was. He also enjoyed helping people, although these days the doctor-patient relationship had changed. Now it was all patient satisfaction scores and other metrics that appeared to have little to do with practicing good medicine. There were days when it was hard to stay in touch with the reasons he’d wanted to be a doctor in the first place.
Susan stuffed the towel into the bin. “Know what I love most? When someone comes in all bandaged up and you never know what you’re going to find when you unwrap it. Man, I love the suspense. Will it be a cut the size of a pinhead or will the finger fall off?”
“You’re ghoulish, Parker.”
“I am. Are you telling me you don’t like that part?”
“I like fixing people.” He glanced up as one of the interns walked into the room. “Problems?”
“Where do you want me to start? There are around sixty of them currently waiting, most of them drunk. We have a guy who fell off the table during his office party and hurt his back.”
Ethan frowned. “It’s not even December.”
“They celebrate early. I don’t think he needs an MRI but he’s consulted Dr. Search Engine and is insisting on having one and if I don’t arrange it he is going to sue me for every cent I’m worth. Do you think it would put him off if I tell him the size of my college loans?”
Susan waved a hand. “Ethan will handle it. He’s great at steering people toward the right decision. And if that doesn’t work he’s good at playing Bad Cop.”
Ethan raised an eyebrow. “Bad Cop? Seriously?”
“Hey, it’s a compliment. Not many patients get one past you.”
Backache, headache, toothache—all commonly appeared in the department, along with demands for prescription pain meds. Most of the experienced staff could sense when they were being played, but for less experienced staff it was a constant challenge to maintain the right balance between compassion and suspicion.
Still pondering the Bad Cop label, Ethan walked to the door but his progress toward the patient was interrupted by the arrival of another patient, this time a forty-year-old man who had suffered chest pains at work and a cardiac arrest in the ambulance. As a result, it was another thirty minutes before Ethan made it to the man with the back injury, by which time the atmosphere in the room was hostile.
“Finally!” The man stank of alcohol. “I’ve been waiting ages to see someone.”
Alcohol and fear. They saw plenty of both in the emergency room. It was a toxic mix.
Ethan checked the records. “It says here that you were seen within ten minutes of arriving in the department, Mr. Rice.”
“By a nurse. That doesn’t count. And then by an intern, and he knew less than I do.”
“The nurse who saw you is experienced.”
“You’re the one in charge so it’s you I want, but you took your sweet time.”
“We had an emergency, Mr. Rice.”
“You’re saying I’m not an emergency? I was here first! What makes him more important than me?”
The fact that he’d been clinically dead on arrival?
“How can I help you, Mr. Rice?” He kept it calm, always calm, knowing that in an already tense environment a situation could escalate with supersonic speed. The one thing they didn’t need in the department was a bigger dose of tension.
“I want a fucking MRI,” the man slurred. “And I want it now, not in ten years’ time. Do it, or I’ll sue you.”
It was an all-too-familiar scenario. Patients who had looked up their symptoms on the internet and were convinced they knew not only the diagnosis but every investigation that should be performed. There was nothing worse than an amateur who thought he was an expert.
And the threats and the abuse were just two of the reasons emergency room staff had a high burnout rate. You had to learn to handle it, or it would wear you down like the ocean wore away at rocks until they crumbled.
In the crazy period between Thanksgiving and Christmas, it was only going to get worse.
Anyone who thought it was the season of goodwill, should have spent a day working with Ethan. His head was throbbing.
If he’d been one of his patients, he would have demanded a CAT scan.
“Dr. Black?” One of the residents hovered in the doorway and Ethan gave him a quick nod, indicating he’d be there as soon as he could.
As attending physician, everyone looked to him for answers. Residents, interns, ancillary staff, nurses, pharmacists, patients. He was expected to know it all.
Right now all he knew was that he wanted to get home. It had been a long, miserable shift and that didn’t seem likely to change anytime soon.
He examined the man thoroughly and explained calmly and clearly why an MRI wasn’t necessary.
That went down as well as he’d thought it would.
Some doctors ran the tests because at least then the patient left happy. Ethan refused to do that.
As he listened to a tirade describing him as inhuman, incompetent and a disgrace to the medical profession, he switched off. Switching off his emotions was the easy part for him now. Switching them back on again—well, that was more of a challenge, a fact borne out by his disastrous relationship record.
He let the abuse flow over him, but didn’t budge in his decision. He’d decided a long time before that he wasn’t going to let his decision-making be ruled by bullying or patient satisfaction scores. He did what was best for his patients, and that didn’t include subjecting them to unnecessary testing or drugs that would have no impact or, worse, a negative impact on their condition.
“Dr. Black?” Tony Roberts, one of the most senior pediatricians in the hospital, was standing in the doorway. “I need your help urgently.”
Ethan issued instructions to the resident caring for the patient and excused himself.
“What’s the problem, Tony? You have an emergency?”
“I do.” Tony looked serious. “Tell me, do you believe in Santa Claus?”
“Excuse me?” Ethan gave him an incredulous look and then laughed. “If Santa existed, he’d probably threaten me for pointing out that not only should he lose a few pounds for the good of his health, but that if he intends to ride in a horse-drawn vehicle at an altitude in excess of thirty thousand feet he should probably be wearing a safety helmet. Or at least leathers.”
“Santa in leather? Mmm, me likey,” Susan murmured as she passed on her way to speak to the triage nurse.
Tony grinned. “Just the cynical answer I expected from you, Black, which is why I’m here. I am going to give you an opportunity you never thought would come your way.”
“A year’s sabbatical in Hawaii on full pay?”
“Better. I’m going to change your life.” Tony slapped him on the shoulder and Ethan wondered if he should point out that after a shift in the ER it wouldn’t take much to knock him flat.
“If I don’t get to the next patient fast, my life will be changed. I’ll be fighting a lawsuit. Can we make this quick, Tony?”
“You know Santa visits the children’s ward every Christmas?”
“I didn’t, but I do now. That’s great. I’m sure the kids love it.” It was a world far removed from the one he inhabited.
“They do. Santa is—” Tony glanced around and lowered his voice. “Santa is actually Rob Baxter, one of the pediatricians.”
“No kidding. And I thought he was real.” Ethan signed a request that an intern thrust under his nose. “That’s the last of my illusions shattered. You have broken my heart. I might have to go home and lie down.”
“Forget it.” Susan was passing again, this time in the other direction. “No one lies down in this place. Unless they’re dead. When you’re dead, you get to lie down and only after we’ve tried to resuscitate you.”
Tony watched her go. “Is she always like this?”
“Yes. Comedy is all part of the service. Laughter cures all ills, hadn’t you heard? What did you want, Tony? I thought you said it was an emergency.”
“It is. Rob Baxter ruptured his Achilles running in Central Park. He’s going to be off his feet until after Christmas. This is close to a crisis for the pediatric department, but even more of a crisis because he is Santa and we don’t have a backup.”
“Why are you telling me this? You want me to take a look at his Achilles? Ask Viola. She’s a brilliant surgeon.”
“I don’t need a surgeon. I need a backup Santa.”
Ethan looked at him blankly. “I don’t know any Santas.”
“Santas are made, not born.” Tony lowered his voice. “We want you to be Santa this year. Will you do it?”
“Me?” Ethan wondered if he’d misheard. “I’m not a pediatrician.”
Tony leaned closer. “You may not know this, but Santa doesn’t actually have to operate or make any clinical decisions. He smiles and hands out presents.”
“Sounds like my average working day,” Ethan said, “only here they want you to hand out MRIs and prescription pain meds. Gift-wrapped Vicodin is this year’s must-have.”
“You are cynical and jaded.”
“I’m a realist, which is precisely why I’m not qualified to deal with wide-eyed children who still believe in Santa.”
“Which is exactly why you should do it. It will remind you of all the reasons you went into medicine in the first place. Your heart will melt, Dr. Scrooge.”
“He doesn’t have a heart,” Susan muttered, eavesdropping shamelessly.
Ethan glanced at her in exasperation. “Don’t you have patients to see? Lives to save?”
“Just hanging around to hear your answer, boss. If you’re going from Scrooge to Santa, I need to know about it. In fact, I want to be there to watch. I’d work Christmas just to see it.”
“You’re already working Christmas. And I’m not qualified to be Santa. Why would you think I’d agree to this?”
Tony looked at him thoughtfully. “You get to make a child’s day. It doesn’t get any better than that. Think about it. I’ll call you in a week or so. It’s an easy and rewarding job.” He strode out of the department, leaving Ethan staring after him.
“Dr. Scrooge,” Susan said. “How cute is that.”
“Not cute at all.” Surely Tony couldn’t be serious? He was the last person in the world who should play Santa with wide-eyed believing children.
He noticed one of the interns hovering. “Problems?”
“Young woman with an ankle injury. Badly swollen and bruised. I’m not sure whether to x-ray or not. Dr. Marshall is busy or I would have asked him.”
“Is she on the hunt for Vicodin?”
